Anesthesia Complicates Our Idea of What It Means to Be Human

In trying to get at questions as broad and incalculable as “What is consciousness?” and “What is memory?” it’s difficult to say where to start. Are they purely questions of neuroscience? Or should philosophy come into play as well?

They’re questions researchers have long struggled with. In 1989, the psychologist Stuart Sutherland wrote in The International Dictionary of Psychology that, when it comes to consciousness, it is “impossible to specify what it is, what it does, or why it evolved. Nothing worth reading has been written on it.” A year later, the biologist Francis Crick, famous for his co-discovery of the DNA double helix, co-authored a paper with the neuroscientist Christof Koch, declaring: “It is remarkable that most of the work in both cognitive science and the neurosciences makes no reference to consciousness … most workers in these areas cannot see any useful way of approaching the problem.” Crick and Koch believed that that there were useful ways of approaching the problem, even if their argument — “relevant neurons” might be the cause of our “inner awareness” — was a bit of a vague stab.

Kate Cole-Adams’s new book, Anesthesia: The Gift of Oblivion and the Mystery of Consciousness, takes a different approach, using a combination of memoir and journalistic inquiry to investigate what consciousness really is. Framing the book around her decision to undergo scoliosis surgery — her initial lack of understanding of anesthesia, her later understanding that exacerbates her fears — Cole-Adams is clearly dedicated to the task. Not only did she undergo surgery herself, she also observed surgeries, attended conferences, spoke with anesthesiologists, psychiatrists, hypnotists, neuroscientists, patients, and read through some of the scientific literature.

But Anesthesia sets itself too tall of a task. Cole-Adams wants to explain not only the vital historical importance of anesthesia, but to also use anesthesia as a gateway to bigger questions about the nature of pain, memory, and consciousness.

By entering into these questions through the lens of the experience of anesthesia, Cole-Adams uses her journalistic talent to carry much of the book. But the trouble with undergoing anesthesia is that you forget the experience. You can only reporton a mute, paralyzed person in so many ways, making this a case where the medium doesn’t match the subject matter: Anesthesia is fascinating precisely because it’s so unknowable, and while a much deeper, more rigorous dive into both neuroscience and philosophy would certainly help in better uncovering its mysteries, a journalist’s tool kit may not be sufficient.

The most interesting stories in the book, then, are the ones where people come “awake” while they’re supposed to be anesthetized — a rare instance, but one that does happen. In the book’s most compelling anecdote, a woman named Rachel Benmayor tells Cole-Adams and some friends about the birth of her second child. Benmayor had been set to have a Cesarean section, and because she hoped to be awake for the birth, she asked to have an epidural rather than general anesthesia. Unfortunately, there was no one available to administer the epidural, and instead she was put fully under — until she suddenly awoke in the operating room.

“All I knew was that I could hear things,” Cole-Adams recalls Benmayor saying. “I could feel the most terrible pain. I didn’t know where I was. I didn’t know I was having an operation. I was just conscious of the pain … I was just trying desperately to breathe, to breathe in. I realized that if I didn’t breathe soon, I was going to die.” She didn’t realize that she was paralyzed, that she looked entirely at ease to everyone in the operating theater, and that she already had a machine breathing for her. She heard the doctors discussing banalities as they stood over her cut-open stomach: “I could hear them talking about things, like about people, what they did on the weekend, and then I could hear them saying, Oh look, here she is, here the baby is.”

Benmayor’s experience, which allows for Cole-Adams to explore an observational instance of reality under anesthesia (since Benmayor was “awake”), brings to the fore two important questions of the book, and of the complexities of anesthesia at large: How do you make a patient unaware of what’s happening? And how do you make sure she doesn’t remember it later?

These questions also naturally lend themselves to further existential inquiry: If we don’t remember an experience — if we have no perception of time — does the experience harm us? Or can harm only happen when, like with Benmayor, consciousness slips through the cracks of anesthesia, a science that’s advanced but not foolproof?

Although Cole-Adams poses versions of these vital questions, the extent of her exploration is ultimately wide but not deep. There are dozens of gripping stories and interviews, but their analysis is often either too brief or too focused on her own experience, like when she speaks to Chris Thompson, an anesthesiologist at the Royal Prince Alford Hospital in Sydney.

“He was still in his scrubs and surgical mask, and my first impression was of a pair of eyes so startlingly intense that for a moment I could not speak,” she writes. They briefly discuss the difficulties of dosage in anesthesia, taking the reader down what seems a promising path — an exploration of medicine as an art, relying on finesse and feeling as much as scientific knowledge.

But Cole-Adams soon loses this as a potential thread. Her concluding words after the section about Thompson — “When I tried to form words or sentences they sounded as if they came from somewhere else, or as if someone else were saying them. It was bizarre. When I think of Chris Thompson I think of him as Mr. Anesthesia” — do little to provide insight into the fertile questions she raises.

Reading Anesthesia, one learns a great deal about the practicalities of anesthesia, the errors that are made, the attitudes of medical professionals about anesthesia, even the history of anesthesia and how (gruesomely) invasive surgery was done prior to its invention. But ultimately, the book stays too close to the surface to sufficiently analyze the grand, existential questions it sets out to explore.